- ChenMed (Philadelphia, PA)
- …RN with bachelor's degree in a related clinical field preferred + A valid, active Registered Nurse ( RN ) license in State of employment required + Compact ... the remaining hours. The Acute Care Manager, Complex Care ( RN ) is responsible for achieving positive patient outcomes, managing...required + A minimum of one (1) year of utilization review and/or case management,… more
- Guthrie (Troy, PA)
- …of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining a ... make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout...degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant… more
- CVS Health (PA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse , including at least 1 year in a hospital setting. + ... A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Wellpath (Lemoyne, PA)
- …or Care Management Certification. + RN preferred. Experience + Previous utilization review and/or case management and pre-certification experience + ... difference** The Regional Care Manager (RCM) works collaboratively with the Utilization Medical Director, Regional Medical Directors, and Site Leadership to… more
- Highmark Health (Monroeville, PA)
- …also building relationships across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care ... Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory… more
- Penn Medicine (Philadelphia, PA)
- …(Outlook, Canopy, CERME, ECIN, shared drive, Internet) **Credentials:** + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... Canopy concurrently + Accounts for all patient days accurately in Canopy + Enters review indicating "pending" status of case if outcome not determined and… more
- Highmark Health (Pittsburgh, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... continuum. Incumbents will utilize nationally recognized standards of practice for case management by collaborating with providers, clinical teams, health plans, and… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Nationally recognized Case Management Certification… more
- Humana (Harrisburg, PA)
- …MRM, SRO **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the (appropriate state) with no disciplinary ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… more
- CenterWell (Harrisburg, PA)
- …of Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse ( RN ) license or Compact State RN ... utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case ...A minimum of 2 years of experience as a Registered Nurse ( RN ). + Background… more